An atypical case history of gluten sensitivity/coeliac disease

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 A Nutritional Therapy Case History

October 2011

The client, a man in his early 50s, presented with severe fatigue. By early afternoon every day, he was so tired that he was sleeping for an hour or two. He had joint pain, brain fog, depression and anxiety. He had no digestive issues, but had suffered from gout since his late teens. As a result, he took NSAIDS (ibuprofen) virtually every day. His diet was generally good, although his alcohol consumption was on the high side. Because of the brain fog, it seemed worth trying a gluten free diet, although there was no indication of digestive distress. On going gluten free, his symptoms were much reduced within 3-4 days. A gluten challenge caused them to return immediately.

2012

The client was well most of the time, although accidental consumption of gluten caused relapses. The ‘gout’, which had never responded to medication was much reduced also, although he continued to take some ibuprofen. His energy levels were variable.

September 2012

The client became extremely unwell following a sailing trip where he may have ingested contaminated water, leading to a probable bacterial or parisitical infection, although nothing was ever found on testing. He had severe diarrhoea which did not resolve itself and continued for 2 months. He remained on a gluten free diet, although was probably cross contaminated on a fairly regular basis, as he travelled for work. He lost 2 stone (12.7kg) in weight during that time. He had pain in the gall bladder area and undigested fat in the stool. Stool tests and ultrasound scans were inconclusive in mid October. A colonoscopy and gastroscopy was booked, but symptoms continued unabated, reaching their worst in mid November when it suddenly stopped. Following the colonoscopy and gastroscopy, biopsies showed coeliac disease.  There is still no indication why the diarrhoea stopped.

2013

The client continued on a gluten free diet, but with much stricter avoidance of cross contamination. He was now extremely sensitive to microscopic levels of gluten or any xanthan gum and he was still extremely fatigued and very depressed.

A programme of gut healing began with colostrum, pancreatic enzymes, probiotics and kefir with St. John’s wort for depression. There was no immediate and obvious benefit, but after a year his tolerances had improved but the fatigue continued. It became apparent that his sleep was poor – not enough cycles of deep sleep and waking very early, feeling not refreshed. He was prescribed intensive adrenal and sleep support, which finally made a huge difference to his energy levels and he was able to return to work full time.

This is an unusual case presentation of coeliac disease. Because the primary symptoms were not gastric, it was not an obvious diagnosis until he caught a ‘bug’.  In my clinical practice, I frequently see clients whose diagnosis of coeliac disease followed some trauma or infection. It may often be the tipping point. There are two other important points about this case – one is that coeliac disease doesn’t always manifest with gut pain, sometimes the other autoimmune symptoms such as brain fog and joint pain are more evident. The other is how long it can take to recover following diagnosis. It is usually believed that on a gluten free diet that recovery is automatic within a year. I often see people who are still feeling under par much later. This case shows that individual nutritional therapy is very useful in achieving a fuller and more complete recovery following a diagnosis of coeliac disease.

Deborah Thackeray

Resistered Nutritional Therapist mBANT

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